WHAAM!

ROY LICHTENSTEIN, 1963

Acrylic paint and oil paint on canvas

My keynote speech at the ML-assisted and 5G-enabled e-Health Systems workshop, (31/1/2020). Please note that was before the COVID-19 pandemic. However, the message is even more urgent in the post-COVID era.

“It is a great honour for me to be here today. And it is an honour for 2 reasons, 1 is because by being here I am back to my roots where I started my journey, and 2 because it gives me the unique opportunity to discuss with you some ideas about our market.

Biotronics3d is active in the market of diagnostic medical imaging and artificial intelligence. Every single month our DC servers receive, analyse and store close to 1 million examinations, sometimes picking at 2M. We serve 120,000 users in 17 countries with thousands of transactions every second and store for them 3PB of medical imaging data. All that is good but I would like to discuss with you what we did next.

It was a few years back when I received a call from Ed Rudd, our chairman. He was very excited about the concept Uberisation of our modern economy, he kept on talking about how most of the business plans he receives (Ed is a keen investor among other things) try to Uberise their market. The Uberisation of everything, he said: “To Uberise, to replace the middleman is the theme of our times.”

For those living in the last few years on a different planet, I think I should explain what Uber is.

Like the gigantic health systems (NHS and the likes), the taxi business model was inefficient, not mobile, and as any passenger using a minicab in London on a Saturday night can testify, often very unpleasant.  It was a model built around the needs of taxi drivers and their companies, rather than me and you, the needs of the guys paying for their services.  Mobile technology and the internet has existed for over a decade, but the taxi industry has simply refused to embrace it, holding on to its old ways. Enter Uber, a Silicon Valley startup.  It uses a mobile platform.  It is GPS-enabled.  It allows you and me, the passenger to rate the driver.  It’s paperless.  It’s efficient. It reduces the cost of service. And while Uber has faced regulatory pushback in almost every country launched, its innovation has seriously disrupted the existing models and it has been handsomely rewarded.  Regulation typically drafts behind, not ahead, of innovation (Brussels please take notice!).

If you think about it, at its core Uber is all about connectivity. How to use an online platform to bring together two communities, the drivers and the passengers. Connectivity is key.

But healthcare also, when you think about it is really about connectivity. We have the basic human connectivity which exists between the patient and the caregiver, and this is as old as recorded human history, probably much older than that. But there is another form of connectivity that is woven into the fabric of the modern health care that is the connection between the caregiver and the body of information needed to provide excellent and personalised care. That body of information can be the knowledge recorded in textbooks, or the data itself, or the opinion of an expert peer. So when you get down to it, the practice of medicine depends on how we handle these two forms of connectivity, our human connection with the patient and our cognitive connection with the information.

The question is how do we solve the connectivity problem and also why should we do that?

Today we are seeing a major shift in healthcare globally, mainly brought by cultural and socio-economic forces and advanced in technologies and consumer behaviours.  The population is ageing and chronic conditions requiring management during patients’ daily lives are on the rise. Alongside these issues, we are seeing widespread connectivity emerge across all economic classes.

Technology has set all of this change in motion. We are already seeing more empowered patients. In our company, we call those patients the “super patients”, the ones who are very close to Dr.Google.  People want information. They want to make their own diagnosis.   They want to research their doctors.  They want to find ways to get to be 100 years old and still enjoy the quality of life. They want to have instant access to clinical skills regardless of where they are.

I am here to talk about a truly novel way in which our business model fuelled by a Cloud platform, 5G and machine learning is poised to make a valued contribution to the transformation of medical imaging and radiology. We call it RaaS-Radiology as a Service, and we believe our concept of RaaS, or to Uberise Radiology will transform our market.

My name is Harry Hatzakis and I am the CEO and co-founder of Biotronics3D. Let me please begin with a confession: I am a CEO who was trained in business only loosely and only much later in his life; However, I fanatically remain and will remain a self-declared nerd, with a profound thirst for technology innovation. I co-founded Biotronics3D back in 2004 trying to create a “controlled” workbench for our crazy ideas and our “what-if” scenario. Many years later, I consider interesting that some of our crazy ideas resonated with a big part of our market and we managed to build commercial success out of it.  Good for us! But what was even better for us, was the copious amounts of adrenaline we felt in our bodies every time we were testing to the market our “what-if” hypotheses for the first time. Because it is extraordinary how much you can push the boundaries of innovation if you lose your ability to sleep at nights; an experience that I feel very privileged to be part of, and I wouldn’t change it for anything.

I am in love with medical imaging, I love the beauty of the data, I have great respect for the subtleties that exist and that when appreciated was an exceptionally skilled eye can save your life. It happens every single day around me, and those are the stories we often like to tell. But of course, medicine remains one of the youngest sciences that consistently humble even the most competent practitioners. Over the years I have witnessed innumerable failures and misfires. Most of those failures are down to break down of communication or shortage of skills or simply human error. These are the stories that should also be told.

Let me please tell you about my market, medical imaging. After 2000 everything changed. What was a traditional product-centric, vertically-integrated healthcare delivery model became an open, complex, very often chaotic, interdependent one.

This concept really hit home for me when my mother, an elderly lady living not far from here, had an MRI and she wasn’t happy with the diagnosis, so she used her laptop, went online and managed to find an expert in Mayo clinic (on her own I must say) to seek a second opinion. 3 hours and $100 later she had that.

Connectivity has changed. People connected 24/7 with mobile devices. New forms of commerce transforming how people can get products and services. Consumers’ expectations, like my mum. that they can get what they want with ease & speed will continue to rise.

At Biotronics3d we imagine a world in the next 10-20 years that looks like this:  Patients receive personal care around the clock.  Virtual coaches and doctors work with patients to optimize day-to-day preventative care.  Everyone has their own virtual care team that lives with them in augmented reality. A wellbeing concierge. Meanwhile, primary care physicians (real humans) are assigned to a pool of patients who they monitor remotely, supported by a team of real human specialists. But much of the “personal” connection will be done through virtual humans (maybe there is a place for IBM’s Watson AI system in healthcare, after all, you clearly need the machines to help us with the deluge of clinical information overload, the clinical information obesity).

And in this brave new world, medical Imaging will be asked to play a major role. I think it will be the catalyst for driving the next evolutionary step in healthcare. Why? Because Medical Imaging is the only way to present a pretty accurate picture of the anatomy and pathology of a person remotely, to a doctor miles away.

It all starts now.  Healthcare must shift its focus toward the patient.  There is no other way. Healthcare services should put the patients’ needs first and foremost. This is what Biotronics3d, our company is doing. Just as Uber has demonstrated with putting the passenger first, ignoring the patient will be fatal for health solutions companies: they will be the new taxi drivers, baffled by how the world has passed them by.

But we cannot do this without three essential ingredients

1. The mobile platform – web-enabled technology:

Where would Uber or airb&b or amazon or eBay be without the mobile platform? At biotronics3d we invested heavily over many years to build this platform, we call it 3dnet, and it provides the digital backbone to our strategy.

2. The network – 5G

While some new technologies are pushing towards and providers further apart, 5G represents an enormous coming together, and in health care bringing pieces together making things simpler, is one and the same of making them safer. It is an open invitation not simply change how we do certain things but to fundamentally rethink how to do all of it. To deliver on our mobile platform we need fast networks and low latencies.

3. The engine – Machine learning

We are facing a matching problem; how do we better match the patient with a doctor and also a doctor with the right kind of information. Effectively we operate with the same principles as an online dating agency matching a pool of men with a pool of women. Modern dating agencies apply AI rules to bring intelligence and automate this matching. We are also investing heavily to apply machine learning algorithms to automate our matching problems. And to keep on the dating agency analogy, first we needed to better profile our various communities.

Before I finish, I would like to please tell you two more things

If you ever watch Travis Kalanick, the founder of Uber, talk about his company, he always defines Uber as a big data company and not as a taxi company. He claims he is in the business of collecting and analysing data related to passengers’ journeys.

Likewise, we are not a PACS/RIS company. We collect and analyse data related to medical imaging. What do we do with that is of paramount importance.  We see tremendous opportunities in aggregating and analysing patient data to improve care and avoid the need for acute care. Technology can do a lot of the heavy lifting in the area of prevention and serve as an early warning system for disease. If we do this, I don’t think we can just improve healthcare, but we can exponentially improve healthcare.

The other thing I would like to tell you is Uber was one of the first companies experimenting with the self-driving car, using the accumulated knowledge they have analysed. Likewise, at the same time, our industry started experimenting with AI for the diagnosis of medical images. The parallels are endless.

……

If you remember one thing from me from today, please remember this:

Solving the big issues of our generation requires bold new business models grounded on the new technologies.

Our industry, medical imaging, faces communication and skill shortage problems. Thus an uber-like approach, using a mobile platform, 5G and machine learning will transform the way healthcare and medical imaging is practised.

The new doctors but also the patients will become to a certain extent data scientists and communication and data hubs.

Thank you.”

NATIVITY

SALVADOR DALI

1959

INK AND WATERCOLOUR ON PAPER

Before we all take some well-deserved rest and relaxation over the holiday season, I’d like to take a moment to reflect on the past year, and to preview the year ahead.

And what a year this has been. Every single one of us has experienced uncertainty and unforeseen challenges as we try to get used to work remotely, whilst trying to achieve a work-life balance.

Despite the global pandemic, the uncertainty of the UK formally leaving the European Union and the range of other macroeconomic shocks – we have all continued to display the resilience, creativity and ingenuity that is so characteristic of the Biotronics3D community. Every single day in 2020 we’ve all shown our strength, but likely we have not had a moment to stop and reflect on all we have achieved this year. Now is the time to acknowledge this: take pride in our accomplishments of 2020, and take stock of the lessons we have learned.

With the recent positive news concerning the vaccine development and rollout, it’s beginning to look like we might see a slow return to normality in 2021. This will hopefully lead to an improvement in the working and living conditions for all of us.

This message would not be complete without me expressing my gratitude and thanks to all the members of the Biotronics3D family who have worked tirelessly throughout the year to ensure we could continue to support and serve our 3dnet community, and who have kept this community thriving.

I hope you and your loved ones stay safe and well, and enjoy a relaxing holiday season.

Best wishes,

Harry Hatzakis

ARTWORK:

TITLE: THE BURNING GIRAFFE

ARTIST: SALVADOR DALI

TIME: 1937

Dear colleagues,

Offering our remote reporting system free of cost and access to skilled radiologists on demand.

Please let me begin by congratulating the NHS and all healthcare professionals whose bravery and dedication in these challenging times, like always, is commendable!

As we peer through the fog of uncertainty, many traditional methods of operating demand restructuring.  We as service providers have been working very hard to adapt and keep our services running, for clients as well as non-clients.

Last week we offered our system and resources at no extra cost to the radiology community, through the ongoing challenges and beyond. However, although the uptake was large, the most common feedback we received was that the challenge being faced now was not a technical challenge only, but also an ‘access to skills’ challenge. Hospitals around Europe do not have enough radiologists to perform their clinical work. And although this is a chronic weakness of our industry, it seems that COVID-19 and the effects of it, amplified the problem to big proportions. As one manager from a big NHS Trust in London told me two days back, it is not only how to get the images in front of radiologist, but it is also how we find the radiologists in the first place.

I think we can help with that.

Biotronics3D is one of the leading providers of zero footprint cloud based RIS, PACS post processing, Teleradiology and Patient Portal in the market today. Our flagship product 3dnet can manage the whole lifecycle of a radiological examination.

Today our system is a lot more than a PACS/RIS. It is a gateway to a community of over 50,000 healthcare professionals, including radiologists (5,000 and counting), referring doctors, researchers and allied professionals in 17 countries. Through our system we can provide on demand access to this community, to help organizations meet the extraordinary demands of managing the COVID-19 outbreak.

As such we offer:

• REMOTE REPORTING PLATFORM AT NO COST:
  1. Our cloud based remote reporting platform is open to doctors and healthcare organisations everywhere at no cost
  2. Our cloud based fully GDPR compliant Patient Portal is open at no cost to help patients access and share their images safely from home
• CONNECTIVITY IS THE KEY:
  1. Staying connected matters more now than ever, and we are working to connect radiologists and healthcare companies as the demand grows.
  2. We are connecting radiologists to diagnostic clinics and hospitals and vice versa.
  3. We are bridging the communication gap between doctors, patients and healthcare organisations through our platform and extensive network.
  4. We are constantly linking radiology providers to radiologists with a passion and WITHOUT A FEE from our side.

Please let us know if you need access to radiologists to cope with the extra demand. We have the platform and access to the radiology community to help you with that.

Biotronics3D stands for delivering excellence. Our professional standards are rooted in reliability and respect. In the current hour of crisis, our priority is to safeguard the wellbeing of radiologists, radiographers, allied professionals as well as patients.

So, whether you are an existing client or interested in learning more about our offers and platform, I encourage you to get in touch with us on info@biotronics3d.com. We do recognise this is a fast moving situation, and our team is working very hard to provide the highest level of support, while continually adapting to changes and demands.

ARTWORK:

TITLE: CHRISTMAS

ARTIST: SALVADOR DALI

TIME: 1974

We’re almost at the end of 2019, and the celebrations of Christmas and New Year’s Eve are here! As we plan for 2020, I have been thinking about the past year and how our team in Biotronics3D has continued to dynamically change and grow in the markets we serve. We have also taken a fresh look at our goals for the coming year, many of which build on 2019’s initiatives and explorations.

Here are some of our 2019 highlights:

• We reached our milestone: the 3Dnet system is used daily across 20 countries.
• We launched our revolutionary teleradiology platform.
• We launched the 3dnet Health Portal to help patients and caregivers to better manage their wellbeing using medical imaging.

The team at Biotronics3D looks forward to what the new year will bring for us.

The following are a few areas we plan to focus on in more depth in the coming year 2020:

• The launch of our new AI-driven platform for teleradiology (hopefully at ECR2020).
• Aiming to reach and even exceed two milestones: the “50,000 registered users” milestone AND the “deployed in 25 countries” milestone.
• Implementing better approaches for co-creating with our partners, the medical image providers, and the medical image innovative companies.

From all of us here at Biotronics3D, we wish you a fantastic Christmas and a bright, innovative start to the New Year.

ARTWORK:
TITLE: THE FRUIT OF KNOWLEDGE
ARTIST: TRAFFORD PARSONS
LOCATION: BIOTRONICS3D ART COLLECTION

My speech for the 15 years anniversary of Biotronics3D.

“A warm welcome to all the guests, friends, relatives and of course to the Biotronics3D team! I thank all of you who have taken their time out to attend this occasion.

February 2019 was a special month: It was our company’s 15th anniversary.

Early on, Soeren and I set the goal to use the internet to change the way Radiologists work. Back then, Radiologists used to ask me, how come that outside of work we can have such a rich internet experience, from buying books to book tickets online, and when it comes to work, we are slaves to a single PACS workstation.

That is why we setup Biotronics3D with the dream to revolutionise our industry. We had a vision for a new technology – everything online, combined with a new business model- SaaS and a new philanthropy model based on medical imaging.

It was a bold idea and a lot of people thought we were out of our minds to

even imagine this was possible. My business friends were saying that we will lose our money and our time if we do it. But our problem was that we could not sleep at nights, we had to do it. So, we invested our money where our mouth was and started the work.

Years later, it is amazing to think how far the adoption of the internet has come in clinical practices and especially in Radiology since then. I think we can all be proud of the role Biotronics3D played in that revolution.

Today we have deployed our system in 17 countries, we have more than 30,000 users, we receive 600,000 studies per month and sometimes we even reach 1 million studies per month. It is amazing, how far we have come in these years since we started.

As they say “those who dream big, achieve big”. So let’s not stop ourselves from dreaming, let’s not settle for less, let’s not restrict ourselves to what is conventional and let’s not let the failures discourage us.

Reflecting on today’s occasion, I would like to share a few thoughts.

Companies are like families. We build them with all our heart, putting our tears, blood and sweat into them, with solely one purpose to fulfill, which is to realise our dreams. And when I say family, I also include our doctors who are part of the same family. In a family, we take care of each other’s wellbeing and make sure that everything functions smoothly. We all take care of the responsibilities we have so that we all, together can make our dream come true. The dream of taking our company to the list of the best Radiology companies in Europe, the dream of making it a company which is known for its ability to innovate, its quality products, quality services and commitment to hard work. Together we can.

For 15 years, we all worked like workaholics. Extending working hours, early logins to the systems, working from home, endless time spent flying, we have done it all when work demanded it. In all these years which have passed, we have seen it all – success and failures, highs and lows, celebrations and crisis, everything. But one thing which we never did was to ‘give up’. This, go-getter attitude, our faith in each other and our commitment towards the company are the factors which have brought us where we are. I would never have been able to picture this successful journey without you people. Our employees have always been my strength and the backbone of the company. Our doctors have always been our source of inspiration and what drives us to excel.

Today though, I am thinking much more about the future of Biotronics3D than its past. I believe the wider adoption of the internet in Radiology will evolve faster in the next 10 years than it has ever done before. We already live in a clinical multi-disciplinary world, where the need to collaborate and access clinical skills remotely is becoming even more pervasive. The facts are that a. procedures are getting even more complicated, b. Radiologists are overwhelmed with the amount of data and c. informed patients desire to play a bigger role in managing their diseases using images to often seek a second opinion and using the internet to consume clinical services online. We are nearing the point where Artificial Intelligence will be able to see diseases more accurately than humans can do, unlocking many new applications and empowering people even more.

Biotronics3D today is better positioned than ever to lead these advances. We have the resources and technology to drive and solve tough problems. We are engaged in every facet of modern radiology and have the deepest commitment to innovation in the industry.

In the coming years, Biotronics3D has the opportunity to reach even more doctors and organisations around the world. Our technology is badly needed in the market, yet it is still out of reach for many people. I hope you will think about what you can do to make the power of our technology accessible to everyone, from Radiologists to Clinicians to the Patients, to connect people to each other, and allow them to collaborate better.

We have accomplished a lot together during our first 15 years and have empowered many clinics, hospitals and doctors to realize their full potential. But what matters most now is what we do next. Thank you for helping make Biotronics3D a fantastic company now and for decades to come.

Keep innovating, keep experimenting, keep growing and keep celebrating our successes. And most importantly, keep the thirst for the journey. I personally wouldn’t change it for anything.

On this note, let the celebration begin! Let’s give a huge round of applause to our unity and efforts. Cheers to this happy occasion, cheers to all of you and cheers to the company we have been nourishing like a baby! I wish you all the very best for the coming challenges and tasks and always remember, together we can make anything happen. Unity has the power to fight back every hurdle on our way.”

 

 

ARTWORK:

TITLE: DUTCH BOATS IN A GALE
ARTIST: JOSEPH MALLORD WILLIAM TURNER
MEDIUM: OIL ON CANVAS
LOCATION: NATIONAL GALLERY, LONDON
TIME: 1801
DIMENSIONS: 162.5 x 221 cm

Yet another ECR (European Congress of Radiology) conference came and went, and with it, it took yet another trend in our industry, that of Artificial Intelligence (AI).

2014-2018 was the period of intense investment and publicity for medical imaging AI. IBM’s acquisition of Merge in 2015, based on the argument of enhanced AI was the catalyst and the accelerator. After that, myriads of start-ups emerged in the space, mainly thanks to Nvidia’s and Google’s very powerful algorithms and libraries, making it simple for everyone to tap into image recognition AI. Those two companies effectively democratized the technology and the market. For instance, last year, a Radiologist friend with very limited software development skills, managed to create what appears to be a very powerful medical image comparison service based on the Google AI service. He was explaining to me that the barrier to entry is not the know-how and the technology, but the primary data collection- accessing and correctly tagging thousands of medical images for training. When it comes to medical Imaging, data is gold and Radiologists are the new Midas of data.

This year, at ECR, the flaw of Medical Imaging AI, which is mainly a business model flaw, became apparent; and this is the risk of extreme commoditization, where the battle for accuracy in findings was turning rapidly into the battle for the price. Take your typical modern Radiologist. Of course, he wants to work with an AI product to assist his interpretation, as long as the claimed accuracy is good enough (and with most of them it is). But he really does not care what the brand is on the black box number crunching the data at the background, in the same way, he does not care what brand of petrol he will fill his car with (as long as the price is not expensive). When it comes to Medical Imaging AI, the 15 letters of the word commoditization are getting more prominent, and all those start-ups very soon will be swimming in their own red ocean.  It was interesting to observe that some of those AI companies recognized the problem and tried to create their own blue oceans, tried to differentiate, to diversify into other not AI related features; but I fear, in the end, it will be the survival of the one with the deepest pockets for them.

So, yet another trendy idea came and went in our industry, an industry I recognize as one of the most fastest moving and innovative in the market.

What is next? Who is the next King? And what is happening to the old King, is he dead?

Dear reader, let me please volunteer my opinion.

I think the next trendy idea in our market, the next King in our market, will be the “Internet of Services (IoS) for Radiology”. But the old King, AI will also be here to stay and grow.

This is very close to what we, at Biotronics3D, do today. This notion is core to our vision. I would define our current model as the “Internet of Things (IoT) for Radiology”. But this is a very short-lived phase, an interim phase, as we observe that the Internet of Things (IoT) will become slowly The Internet of Services (IoS) for Radiology. Our industry is going through the same evolution as the telecommunications industry.

What is the “Internet of Services for Radiology”?

Let’s start with some definitions:

A service is a commercial transaction where one party grants temporary access to the resources of another party in order to perform a prescribed function and a related benefit. Resources may be human workforce and skills, technical systems, information, consumables, and others. 

In our industry, the service definition above covers a broad range of services. It is, therefore, useful to define criteria to classify those services. The most obvious classification is perhaps based on the digital footprint of a service. How and to what degree information technologies like ours are used to instantiate a service.

As an example, think about teleradiology services. The traditional teleradiology service (popularised in the 90s by my very dear friend, Dr. Phil Templeton), is about granting access to some Radiological remote skills and sending radiological examinations from one point to another. This process is the transition phase between IoT and IoS. When it is fully evolved to pure IoS the bi-directional information flow associated with those services combined with user behaviors will become more and more important. As an example, information about Just in Time quality of teleradiology services, is as important as the teleradiology service itself.

Increasingly we perceive Biotronics3D as the facilitator of the Internet of Services (IoS) for Radiology.  The hosts of an imaging network of people and skills that is rapidly expanding in size and complexity where data and services are standardized, monetized and traded for the value of all.  In this Brave New World of IoS for Radiology, we will be pioneers.

I also predict that AI will play a major role in the Internet of Services for Radiology, but it will not be the main focus. At Biotronics3D we have recognized this and we have embarked on research on how AI can be used within an IoS for Radiology framework. Our Innovation Centre in Edinburgh is very busy with this research.

But the coming of the new King is not without challenges.

One challenge is to find an appropriate understanding of the term “Services for Radiology”. In order to form the Internet of Services for Radiology, services have to be described in such a way that the business dimension and the technology dimension come together.
Service providers in our industry will have to describe the business aspect of a service while at the same time services have to be described in a way that systems can automatically understand and link services.

The second challenge will be around the standardisation of services. A common understanding and a way to codify radiological protocols will be needed. For example, an MRI protocol for prostate cancer has to have the same meaning across a wider healthcare network.
I think as Biotronics3D is heavily involved in technologies and business models of IoS for radiology, we increasingly see how the future of the web-based service economy in Medical Imaging will look like.

Enterprises (like for example our customers Affidea, http://www.affidea.com)  will eventually use our technologies and the Internet to build and provide huge numbers of new kinds of services that go beyond old-fashioned teleradiology services. Services that are available on the Web separately will be combined and linked with one another resulting in aggregated value-added services.

Using web technologies, services will become more widely and easily available. Imaging Centres will open their business processes to others to form value networks which will be, in the end, a necessity for success in our very competitive markets. The Internet of Services is expected to ensure profitability and further growth of our sector.

The King is dead, long live the new King.

ARTWORK:

Title: Tarjeta Navidenas

Artist: Salvador Dali

Time: 1958